Can we please talk about how vindicated I am by this Public Citizen report? At long last, a comprehensive and structured look at the conflicts of interest and affiliate relationships in MAHA world, timed to coincide with Casey Means’s confirmation hearings. I’ve been banging this drum for a long time. Consider this excerpt from an as-yet unpublished draft of something I wrote about MAHA, back in October:

Surgeon general nominee Casey Means, a medical residency dropout turned “functional” doctor, exemplifies many of these currents. Her philosophy (to characterize it generously) is individualistic, pseudoscientific, obsessed with weight and nutrition; her means of propounding it is affiliate marketing. Her pre-nom claim to fame, if fame it is, was a 2024 book called Good Energy: The Surprising Connection Between Metabolism and Limitless Health. She takes money from various wellness peddlers to promote all manner of creams and supplements on her social media accounts. It doesn’t stop with commissions, either, she’s no mere downline girlie. She’s also the co-founder of a health tech wearables company (wearables are things like continuous glucose monitors) called Levels. In June of this year, RFK Jr. told the House Committee on Energy and Commerce that HHS planned to launch an advertising blitz in service of Kennedy’s “vision” that “every American is wearing a wearable within four years” because “wearables are a key to the MAHA agenda.” At the beginning of Trump’s second term I joked that the end game was to get the remnants of Medicare and Medicaid to reimburse distance reiki. I didn’t quite know how right I was. Wearable technologies, according to Kennedy, “allow people [to] take control over their own health,” indeed a key MAHA theme, and as such, HHS is “exploring ways of making sure that these costs can be paid for.” Such ways may well include Means’s twin brother Calley, a self-described entrepreneur and, since 2025, Special Government Employee at HHS under Kennedy. Calley’s company Truemed, founded in 2022, is a platform that facilitates the use of tax-advantaged medical spending accounts like FSAs (flexible spending accounts) and HSAs (health savings accounts) on wellness products. How this works in practice, essentially, is that Truemed will provide a letter certifying medical need for things like the red light masks popular on Tiktok or, say, a wearable glucose monitor from Levels. Behind the sheer goofiness of what these people purportedly believe, about “mitochondria” and metabolism and seed oils and all that rest of it, is a serious effort to build the infrastructure to use HHS and other health agencies for self-dealing, just as Trump is using the presidency.

 And here’s the Public Citizen report, playing the very same tune:

Dr. Means co-founded and serves as chief medical officer and advisor to Levels, a membership-based health tech and wearables company that provides continuous glucose monitoring and lab testing for metabolic health markers, such as blood sugar and cholesterol. Levels is not marketed to people who have diabetes, the typical population wearing glucose monitors, but instead focuses on people who want to “optimize their health.” These types of products are a focus of Secretary Kennedy, who has vociferously promoted wearables and announced “one of the biggest advertising campaigns in HHS history” to encourage their use. Kennedy told the House Committee on Energy and Commerce that his “vision is that every American is wearing a wearable within four years." Kennedy specifically cited glucose monitoring wearables as having “utterly changed” the lives of some of his friends. After Kennedy’s statements, glucose-monitoring device makers saw a jump in their share price… Customers have the option to purchase Levels testing kits tax free through their Health Savings Accounts/Flexible Spending Accounts (HSA/FSAs) from Dr. Means’ brother Calley Means’ company TrueMed (which Dr. Means is also invested in). Dr. Means’ investment in Levels could be worth as much as $500,000, according to her financial disclosure. In addition to her role as a co-founder and advisor to Levels, Dr. Means also collects fees for promoting Levels on her platforms.

From the report, I also learned about MAHA meat influencer Paul Saladino, whose

wellness company Heart & Soil is also a featured partner of TrueMed. Heart & Soil promises to “unlock the power of organs” with capsules filled with desiccated organ meat marketed as nutritional supplements. Its products include “Her Package,” a “female health” supplement made up of cow ovaries, uteruses, and fallopian tubes that claims to “improve cramping, PMS-related symptoms, and infertility” and provide “Strategic support for women struggling with reproductive health, menopause and perimenopause.”

I actually didn’t know anything about Saladino when I wrote about the politics of industrial meat waste and shit last week but there you have it. The report also describes at length some of Casey Means’s many, many affiliate marketing partnerships (I’ve also written about affiliate marketing): 

In addition to her role with Levels, Dr. Means is a prolific influencer, maintaining a website, weekly newsletter, and robust social media presence where she posts about wellness and promotes wellness products. She has 200,000 newsletter subscribers, 852,000 followers on Instagram, 86,300 followers on TikTok, and 230,200 followers on X/Twitter…  Public Citizen’s review of Dr. Means’ website, newsletter, and social media feeds found that for the almost two dozen companies from which Dr. Means reported receiving affiliate fees, Dr. Means disclosed her financial relationship inconsistently and ambiguously. In total, she failed to disclose her financial relationship 79 out of 140 (56%) times she promoted affiliated products. 

Of course, many of the companies Casey promotes (and is invested in) have suboptimal track records when it comes to sound business practices and consumer safety. Genova Diagnostics (which Casey received $20,000 to promote on her newsletter) paid $43 million to settle a case involving billing (defrauding) Medicare and Tricare for medically unnecessary allergy tests. Daily Harvest (which paid Casey $12,000 to promote on her newsletter) settled a class action lawsuit for $23 million last year over hundreds of cases of acute liver failure and other medical issues linked to their “French Lentil + Leek Crumbles.” (The culprit was tara flour, which, consistent with MAHA’s desire to consume byproducts and waste, is not really food.) From EnergyBits – algae tablets allegedly containing unsafe levels of lead – she got $27,000; from Momentous (protein powder, full of lead) she got $40,000; from Pendulum Therapeutics, a “probiotic company that partners with TrueMed,” she got $27,000. 

The list goes on. It’s a grab bag of bullshit, and it is a lot of money. If it’s in Casey Means’s newsletter, she’s getting paid to promote it, even if that is not disclosed. That is the entire raison d’être of the newsletter, there is no point to her having a newsletter or a social media presence if not to pump this horseshit and collect the affiliate fees. It almost insults Casey’s hustle to pretend that there is or ought to be some medical or public health purpose to any of it. Actually doing medicine or public health is hard work and insanely inefficient as a way to make money. It’s generally much harder to make influencer money or affiliate marketing money out of the health care system by doing it the “right” way, so they’re simply doing it the wrong way. They don’t care. It’s about sucking up to the spigots of federal health spending like foie gras geese. This has long been my analysis of MAHA.

The issue with Casey Means is that she is a cornerstone of this whole structure of corruption, affiliate marketing, and self-dealing. The other issues with her – that she’s unqualified, dumb as a rock, endorses quack beliefs, that she’s mealy-mouthed on vaccines to avoid pissing off RFK Jr. – are straightforward consequences of this main issue. Offering a scientific view of vaccines in her confirmation hearings would be biting the leathery hand that feeds her. Why on earth would she do it? Her willingness to cheerfully promote unregulated supplements that might fatally poison you isn’t a function of her lack of qualifications, even less so of a coherent and principled ideological agenda. (Indeed, I think reading everything through the lens of “eugenics” is actually imposing an ideological structure and consistency on MAHA that it simply does not have.) Attacking these people on the finer points of public health or medical ethics, let alone erudite academic points about “logics,” is futile. They are slop merchants who get paid, dollar signs in their eyes, cash register ca-ching! as their tongues loll out, each time a child dies of measles, lead poisoning, hemolytic uremic syndrome, liver failure, or any of the other goodies they have arrayed for you as a reward for purchasing and consuming the garbage they’re selling. Your body, your children’s bodies, are machines that turn slop, excrement, and poison into profits for them. Good luck to you if you actually need to go to the doctor, but that’s not their problem. 

It’s maddening that the opposition to her nomination, and to the MAHA takeover more generally, has been so tepid and ineffectual. It should be relatively easy to deflate her nomination bid on the basis of her intractable conflicts of interest and corruption. But nobody is really making a principled stand there. The “health left” (my friend always refers to the “health left” but I think of it as something like Mothman, in that I’m not sure I believe it exists) is hopelessly snarled in its own jargon and hopelessly captured by the incentives of subscription-based content creation. This is (as Perry Anderson suggests about so-called Western Marxism) a consequence of political defeat, destruction of public education, and a sequestration away from actual, material struggle at the level of mass politics, which doesn’t make it any less frustrating. The situation within public health is even grimmer – no material politics at all, or awareness of any such thing, just a personal investment in how “misinformation” is eroding public health and the respect afforded to experts, in many cases one and the same thing. Can we chart an actually socialist position on things like the Means nomination that doesn’t require a PhD in cultural studies or public health to understand? Such a position requires, I think, a concept of a “public” that we don’t really have among our increasingly meager theoretical appurtenances. An imaginative concept of a public goes beyond how most of us understand it (a model of funding or finance that is non-private) would make it much easier to establish how Casey Means is a self-interested grifter, and until we can configure something like it we’re doomed to fight this battle in the muddy trenches of scicomm.